GOP governors welcome extension on health exchange decision

Last week was marked by a flurry of state-level activity related to the health law's insurance exchanges: News outlets run down which states have decided to develop their own marketplaces and which will defer to the federal government. A number of states, many with Republican state executives, are still seeking more information.

Politico Pro: States Take Advantage Of Extension
They asked for more time, and now they're going to use it. Most of the states that hadn't announced an exchange decision before HHS pushed extended the deadline said Friday that they're going to take the extra month to think things over. States originally had until Friday to indicate whether they'd build their own exchanges, but HHS pushed the deadline back to Dec. 14 after the Republican Governors Association requested more time -- and much more guidance from the feds. For the most part, governors were grateful for the bonus time, but also strongly suggested that HHS would be well-served to quickly clear up states' major exchange questions (Millman, 11/16).

Reuters: Five Republican Governors Reject State-Run Health Markets
Five Republican governors rejected on Friday a major provision of President Barack Obama's health care reform law that calls on states to set up online health insurance markets where consumers can purchase private coverage at federally subsidized rates. That makes it likely that the federal government will establish its own markets, known as health care exchanges, in those states and potentially supplant state control of private individual insurance markets (Morgan, 11/16).

The Associated Press: GOP Govs Of Iowa, Neb. Differ On Health Exchanges
Iowa and Nebraska are turning down different paths to comply with the federal health care overhaul, which reflects the broader struggle many Republican governors face now that they must submit to a law they feverishly oppose. Iowa Gov. Terry Branstad said Friday that his administration will continue to work on a state-based exchange, but he left open the possibility of defaulting to a federal exchange or some combination of the two (Schulte, 11/19).

Politico Pro: Iowa To Build Exchange, But Wants Details
Iowa will pursue a state-run health insurance exchange -; even though it's annoyed at the Department of Health and Human Services and might still change its mind. In a letter to HHS Friday, Gov. Terry Branstad, a Republican, swam against a tide of GOP governors refusing to proactively implement the Affordable Care Act, permitting the feds to set up an exchange in their backyard instead. "I write you today to inform you that Iowa will continue on its path to creating an Iowa-based exchange that is intended to protect the health of Iowans … I continue to have concerns that an intrusive federal exchange would raise costs on individuals and businesses, making it harder for them to create jobs and raise family incomes in Iowa," he wrote in a letter to Sebelius (Cheney, 11/16).

Politico Pro: GOP Governors Open Doors To ACA
Bobby Jindal's got a funny way of showing how much he hates Obamacare and Washington bureaucracy: The Louisiana governor's about to invite the feds to set up a health insurance exchange right in his backyard. So is Rick Perry in Texas. Ditto for John Kasich in Ohio. And Scott Walker in Wisconsin. These Republican governors, and more than a dozen others in red states around the country, have decided it's better to have Obamacare forced on them than to legitimize it by setting up their own exchanges, even if that means empowering the federal government at the expense of the states. It's a stick in the eye of a just reelected president whose health care plan is still opposed by about half the country -- and an indication that some Republican governors have no intention of backing down just because President Barack Obama won another four years (Allen, 11/16).

Los Angeles Times: California Works to Get Word Out On Health Insurance Exchange
With the presidential election over and the nation's health care overhaul moving forward, California officials have less than a year to clear up widespread uncertainty about future medical coverage options (Gorman and Terhune, 11/ 19).

California Healthline: Long Busy Day For The Exchange Board
The Health Benefit Exchange board issued a draft establishment grant proposal Wednesday, which is basically a blueprint of the exchange's business and operational plan through 2017, the year it is supposed to become self-sufficient. The board also took on a number of other issues on Wednesday, including imminent submission of its quality health plans proposal to the Office of Administrative Law. The eight-hour meeting had a get-down-to-business tone, partly in response to the reelection of President Obama, which ensures a smoother track for implementation of the Affordable Care Act (Gorn, 11/16).

The Hill: Health Law Author Calls On Christie To Set Up Exchange
An author of the health care law is calling on New Jersey Gov. Chris Christie (R) to set up his state's insurance exchange and not leave the task to the federal government. Christie has not announced his decision. The deadline for states to say if they will run their own exchanges was pushed back from Friday to Dec. 15 to accommodate Republican governors. Rep. Frank Pallone Jr. (D-N.J.) wrote to Christie on Thursday as the original deadline loomed, urging him to sign a bill passed by the State Legislature that authorizes a New Jersey-run exchange (Viebeck, 11/16).

The Associated Press: Walker's Health Care Decision Ripped By Democrats
Gov. Scott Walker's decision to hand off creation of an online marketplace to connect Wisconsin consumers with private health insurance providers riled Democrats and others who hoped he would support a state-run exchange despite his opposition to the federal law. But Walker stayed true to his longtime opposition to President Barack Obama's Affordable Care Act, derided by Republicans as "Obamacare," with his decision Friday to join with other Republican governors in ceding authority for creating the exchanges to the federal government (Bauer, 11/16).

Milwaukee Journal Sentinel: Many Decisions Remain On Wisconsin's Health Care Exchange
Judy Neary of Brookfield has mixed feelings about the Affordable Care Act and knows little about the online marketplaces, or exchanges, for health insurances that are to be in place by late next year under the law. But she knows the frustration of shopping for health insurance and the idea of an exchange intrigues her. "I would definitely use that," Neary said. The exchanges, a key component of the Affordable Care Act, have the broad goal of making it easier for people and small businesses to compare health plans, potentially increasing competition and helping to slow the rise in premiums and health care costs (Boulton, 11/17).

St. Louis Beacon: Missing Deadline Won't Prevent Missouri From Setting Up A Health Exchange
Today marked the first major deadline for states planning to set up their own health-insurance exchanges as mandated by the Affordable Care Act. And Missouri Gov. Jay Nixon followed through with a letter Friday to the federal government stipulating that the state will be unable to meet the deadline, and won't be setting up a state exchange. But missing the deadline, as Missouri is doing, doesn't mean a state can't create an exchange in a later year. Kathleen Sebelius, secretary of health and human services, made that point in a letter Thursday to some state lawmakers, saying "A state may apply at any time to run an exchange in future years." Observers say that's one of the overlooked issues surrounding the controversial health reform law (Joiner, 11/16).

The Associated Press: Deal: Ga. Won't Create Health Care Exchanges
Georgia will not create the health insurance exchanges required under President Barack Obama's health care overhaul and will leave that task to federal authorities, Gov. Nathan Deal said Friday. Deal, a Republican, outlined his stance in a letter to the U.S. Department of Health and Human Services in which he criticized the Democratic health care plan for what he called its "one-size-fits-all approach" and the financial burdens it places on state governments (Henry, 11/16).

The Associated Press: Mead Says Feds Are Ducking Health Care Questions
Wyoming Gov. Matt Mead has expressed mounting frustration with the Obama administration, saying the secretary of Health and Human Services has not answered his requests for additional information regarding the federal health care law. Mead wrote to HHS Secretary Kathleen Sebelius on Friday stating that her department's failure to respond to a pair of earlier letters means the state will likely miss a key deadline next month (Neary, 11/16).

The Associated Press: Illinois Keeps Pace On Obama's Health Law
Illinois is ahead of some states but behind others on the path toward creating a health insurance exchange, a cornerstone of President Barack Obama's health care law. Obama's home state plans to partner with the federal government to run a health insurance exchange beginning in 2014, the first year for coverage. State officials submitted their blueprint for that partnership Friday (Johnson, 11/16).

The Associated Press: Scott Wants To Meet With Federal Health Officials
Gov. Rick Scott told federal health officials in a letter Friday that he isn't convinced a state health exchange will lower health care costs for Floridians, and that he's worried the actual costs could end up exceeding early estimates. The Republican governor, who has recently softened his staunch opposition to the federal health care law, requested a meeting with federal health officials in hopes of working together to set up a state health exchange to help the nearly 4 million uninsured in the state. But Scott said he needs more information before making a decision (Kennedy, 11/16).

Minnesota Post: Dayton Administration Commits To State-Run Health Exchange
The Dayton administration on Friday sent an early signal to the federal government that Minnesota will pursue a state-run health insurance exchange and apply for an additional $39 million in grant funding to develop the tool, a crucial component of the federal health care reform law. The U.S. Department of Health and Human Services postponed two key Friday deadlines till mid-December, but Minnesota pushed ahead anyway, emphasizing Gov. Mark Dayton's commitment to implementing the exchange. Federal funding for the project will top $100 million if the grant is approved. With DFL majorities in the Legislature, what once looked like a lonely project for the executive branch has become one of the most important issues for lawmakers this session (Nord, 11/16).

CQ HealthBeat: Insurers Could Face Fees To Help Pay Exchange Administration
One of the main rationales GOP governors gave this week for their decisions not to run their own exchanges is that it would cost their taxpayers less in administrative expenses if they let the federal government do it. That raises a question: How would the federal government pay for the costs of operating an exchange? One strong possibility is that federal officials would impose a fee on insurers in the exchange, said a former federal official Friday. Those costs for insurers would probably be passed on to consumers. A number of states that will run their own exchanges are also considering user fees. Already, the Massachusetts health insurance exchange market, which was a model for the federal framework, assesses fees on insurance plans in its exchange (Adams, 11/16).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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